October 2018 Asian Journal of HUMAN SERVICES Printed 2018.1030 ISSN2188-059X Published by Asian Society of Human Services A s i a n S o c i e t y o f H u m a n S e r v i c e s VOL.1 5
October 2018
A s i a n J o u r n a l o f
HUMAN SERVICES
Printed 2018.1030 ISSN2188-059X
Published by Asian Society of Human Services
A s i a n S o c i e t y o f H u m a n S e r v i c e s
VOL.1 5
DOI:http://doi.org/10.4391/ajhs.15.38
Asian Journal of Human Services, VOL.15 38-51
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ORIGINAL ARTICLE
Effects of a Structured 8-week Nordic Walking
Exercise Program on Physical Fitness in the
Japanese Elderly
Takayuki KAWAMURA 1) Reiko SUZUKI 2) Jarmo PERTTUNEN 3)
1) Faculty of Health Sciences, Tohoku Fukushi University, Japan
2) Proactive Health and Wellbeing Center, Tohoku Fukushi University, Japan
3) Tampere University of Applied Sciences, Finland
ABSTRACT
Although Nordic Walking (NW) is a fast growing form of exercise in Europe. This study
aimed to determine how a supervised NW exercise program affects basic fitness and
examine its application as a sports activity for supporting the health of elderly. Forty
participants were randomly assigned to the NW group (NW: 66±4 years old) or the
control group (CO: 68±4 years old). Functional measurements included the sit-and-reach
test, timed-up and go test (TUG), knee extensor strength assessment, and incremental
shuttle walking test (ISWT). Throughout the ISWT, the heart rate (HR) of each subject
was monitored. Static balance was measured with a force platform under four test
conditions: normal standing, with eyes open and closed, semi-tandem, and tandem
standing with eyes open. These measurements were taken before and after the 8-week
NW program. The NW group exercised 60–90 min/session, 3 times/wk. Results showed
that NW training had positive effects on the TUG test, flexibility, and knee extensor
strength (p < 0.05) assessments. In contrast, knee extensor strength was decreased in the
CO group throughout the duration of the study (p < 0.05). The NW group walked with
significantly lower HRs from level 1 (1.8 km/h) to 5 (4.3 km/h) after training (p < 0.05).
However, there was no significant difference in HRs for the CO group during the ISWT.
There were no significant changes between the groups in any of the four platform tests.
In conclusion, the 8-week NW program either improved or maintained flexibility, leg
strength, and cardiorespiratory endurance with no measurable changes in static balance.
<Key-words>
nordic walking, cardiovascular fitness, static balance, elderly, muscle strength
[email protected] (Takayuki KAWAMURA; Japan)
Asian J Human Services, 2018, 15:38-51. © 2018 Asian Society of Human Services
Received
August 20, 2018
Revised
September 13, 2018
Accepted
October 5, 2018
Published
October 30, 2018
DOI:http://doi.org/10.4391/ajhs.15.38
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I. Introduction
Life expectancy and retirement age are increasing worldwide, Japan being the fastest
aging nation (Statistics Bureau, Japan, 2018). Because of this change, maintenance of
mobility has become a vital part of a good quality of life and working capacity. In aging
neuromuscular control declines (Delbono, 2003) and muscle mass (Nair, 2005) and
cardiorespiratory performance decrease (Sanada, Kuchiki, Miyachi, et al., 2007). These
factors promote instability in common daily movements thereby increasing the risk of
falls. It is a well-known phenomenon that the improvement of mobility and balance
prevents falls and fractures (Kannus, Sievänen, Palvanen, et al., 2005).
Nordic Walking (NW) is a popular and fast growing form of exercise in Europe.
Previous studies have demonstrated that NW has both short-term and long-term effects
on cardiorespiratory performance. Studies by Porcari, Hendrickson, Walter, et al. (1997)
and Church, Earnest & Morss (2002) have found that walking using poles resulted in
significant increases in VO2, caloric expenditure, and heart rate (HR) responses in
comparison to walking without poles on a treadmill. Conversely, Schiffer, Knicker,
Hoffman, et al. (2006) found that NW resulted in fairly small increases in HR and VO2.
The pooling technique (e.g. intensity of pooling) seems to be the reason for
inter-individual differences and the degree of improvement in oxygen consumption
(Church, Earnest & Morss, 2002). The increase is due to increased muscle activity in the
upper body muscle groups (Koizumi, Tsujiuchi, Takeda, et al., 2008).
To the best of our knowledge, there are not many published studies available examining
the long-term effects of Nordic Walking. Stoughton (1992) studied muscular and aerobic
fitness responses before and after 12 weeks of exerstriding and walking training in
sedentary women. In their study, the participants were subdivided into three groups: a
walking group, a walking group with poles, and a control group. The maximal aerobic
power increased significantly in both exercise groups, which was 8 and 19%, respectively,
for each group. Muscular endurance improved by 37% in the Exertrider group and by
14% in the walking group. In contrast, Kukkola-Harjula, Hiilloskorpi, Mänttäri, et al.
(2007) identified only moderate increases in peak VO2 (2.5 ml/min/kg) after 13 weeks of
training in 50–60-year-old sedentary women.
The results demonstrated that NW is a suitable exercise method for the elderly and
NW may improve functional capacity safely and effectively in this population. However,
the knowledge of how NW affects aerobic and functional capacity among the elderly is
still lacking. Furthermore, randomized controlled studies are also needed with global
participation (e.g. Japan). Thus, the aim of this study was to explore the effects of a
structured, 8-week NW exercise program on mobility, functional capacity, and physical
conditions in elderly Japanese men and women.
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II. Subjects and Methods
1. Subjects and Procedures
Community dwelling elderly were recruited from annual medical checkups in
Yamamoto town (Figure 1). A subject group was chosen from an age group ranging in age
from 60–70 years. All subjects were able to walk independently (i.e., not dependent on
mobility aids) and stand (≥ 1 minute) and walk (≥ 1 km) without any assistance. To
prevent potential confounding effects from other exercise programs, volunteers who
regularly (≥ 1 day per week) participated in a supervised exercise program were
excluded.
The study plan was explained and written informed consent was obtained. Forty
subjects were stratified according to age and sex, then the community nurse who was
independent of this study randomly assigned the participants to an exercise (n = 20) or
control (n = 20) group. Group assignment was revealed following baseline testing. All
studies were performed according to a research protocol approved by the Ethical
Committee of the Tohoku Fukushi University.
<Figure 1> Flowchart of recruitment and inclusion of study participants.
NW=Nordic walking
Answered
“interested in
NW” (n=269)
Eligible participants
(n=40)
Attended information
session (n=65)
Excluded (n=25)
Not meeting inclusion criteria
Age(n=2)
Health(n=3)
Claimed “Exercise regularly”
and/or “Highly fit” (n=17)
Unwilling to participate (n=3)
NW group
(n=20)
Control group
(n=20)
Completed (n=19)
Withdrew before
baseline
assessment (n=1)
Completed (n=19)
Fall Injury after
baseline
assessment (n=1)
Replies to questionnaire (n=658)
“Are you interested in NW?”
Answered
“Not interested in
NW” (n=389)
Invited to information session
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NW poles were provided by Exel Ltd. Each exercise in the NW group was supervised by
2–3 trainers and community volunteers experienced in NW. The trainers were certified
as Activity Leaders and/or Basic Instructors by the Japanese Nordic Fitness Association
(JNFA). The NW group exercised for about 60 min (5–10 min warm-up, 20 min NW,
stretching between sessions, 20 min NW and 5–10 min cool-down), 3 times per week for
8-weeks. Intensity of the NW was based on their rate of perceived exertion (RPE), which
did not exceed 13. The walking distance progressed through three stages: the 1st stage,
1.6–2.4 km (1–8 sessions); 2nd stage, 2.4–3.6 km (9–17 sessions), and the 3rd stage,
3.6–4.8 km (18–24 sessions), At the 1st stage of the training program, subjects were
provided technical instructions for about 20 minutes after the warm up.
At the 2nd session and 11th session, 800 m walking time, RPE, and HR (Polar Electro,
Kempele, Finland) were recorded to assess the physiological intensity of NW. HR was
analyzed during the last 400 m. RPE was assessed immediately after completing 800 m
of NW.
For the control group, the community nurses provided phone calls every other week to
discuss health-related topics, which were not related to physical exercise. Otherwise,
they were asked to continue their usual daily activities. All subjects were asked to refrain
from initiating any other new exercise programs, or otherwise consciously changing their
activity levels during their participation in the study.
2. Physical Fitness Measurements
After the 8-week NW exercise period, the same measurements were repeated for all
subjects. The physical fitness tests included to sit-and-reach test for flexibility, timed-up
and go test (TUG) (Podsiadlo & Richardson, 1991) for functional mobility, knee extensor
strength for lower extremity strength, and the incremental shuttle walking test (ISWT)
(Singh, Morgan, Scott, et al., 1992) for endurance fitness. Flexibility was measured by a
sit-and-reach test (Yamamoto, Kawano, Gando, et al., 2009) using a digital flexibility
testing device (T.K.K.5112; Takeikiki Co. Ltd, Tokyo, Japan). Isometric knee extensor
strength was measured bilaterally using a Musculater GT-50 (OG-giken Co. Ltd.,
Okayama, Japan). The subjects sat on a specially designed chair secured with straps
fastening the trunk and thighs to fix their hip joint at 90 degrees and a knee joint at 70
degrees. The lower leg was tightly strapped to a strain gauge transducer placed just
above the ankle. Subjects were asked to exert three-second isometric maximal voluntary
contractions against the strain gauge transducer. Two attempts were carried out at
three-minute intervals. The real-time force applied to the force transducer was displayed
and the peak value was recorded. Peak extension torque was calculated by the
multiplication of force with the length of lever arm for each subject. In each of the
functional tests, the best of two trials was chosen for analysis.
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In the TUG (Schiffer, Knicker, Hoffman, et al., 2006) assessments, an armchair of
comfortable height was used and a distance of 3 m was marked with a line of tape and
cone on the floor. The starting position was sitting with hands resting on the arms on
their thighs. The participants turned around and walked back to sit down in the chair
again. They were instructed to perform the TUG at their normal and maximal speed and
they performed one trial before they were timed. The timing of the TUG started when the
participant’s back came off the back of the chair, and stopped when their buttocks
touched the seat of the chair again.
For the ISWT, subjects were instructed to walk between two markers (visible tape on
the floor) set 10 m apart in a straight line on the flat surface. Pre-recorded bleeps on a CD
were emitted from a CD player. At 1-min intervals the time between each bleep
shortened, indicated by a triple bleep, and the number of shuttles increased. The ISWT
consisted of a maximum of 12 levels, when subjects failed to achieve the set pace, the
number of shuttles they had completed was recorded. Throughout the ISWT, each
subject’s HR (Polar Electro, Kempele, Finland) was monitored. The test stopped when the
subject did not reach the tape at the same time as the bleep by 0.5 m on two consecutive
occasions, showed signs of physical injury or distress (as indicated by HR), or no longer
wished to continue.
Using the force platform, balance was tested in four different test conditions: (1)
normal stand test with eyes open on the balance platform (HUR Labs Oy, Tampere,
Finland) with a clearance of 2 cm between the heels, at an angle of 30 degrees between
the medial sides of the feet; (2) normal stand test with eyes closed; (3) semi-tandem test
with eyes open, the participant placed the heel of one foot along the side of the big toe of
the other foot; (4) full tandem test with eyes open, the feet were positioned heel-to-toe
along the midline of the platform. The participants performed one trial of each test in the
following order (1) to (4) and repeated the trail after a few minutes’ rest. We instructed
the participants to gaze at a point marker at eye-level at a distance of 2 m and to stand as
motionless as possible during all tests. The data sampling rate was set to 50
samples/second, and test duration was 30 seconds for each condition. For data analysis,
we used standard posturographic parameters derived from the center-of-pressure (COP),
90% confidence ellipse area (C90A), trace length (TL), sway average velocity (SaV), and
standard deviation velocity (StdV). In the analysis of the balance data, the subject’s best
trial was chosen.
3. Statistical analysis
Data were analyzed using the SPSS statistical software package, version 14.0 (SPSS
Inc., Chicago, USA). Comparisons between the two groups were performed using either
the Mann-Whitney test or the chi-squire test for nonparametric variables and the
independent samples t-test for parametric variables. The training parametric data were
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analyzed by repeated-measures ANOVA with post-hoc test. All data with a p < 0.05
confidence level were considered statistically significant.
III. Results
1. Subject Characteristics
One participant from the NW group did not complete the study, and the subject’s
baseline data were excluded. Attendance at training sessions for the NW group was 90%.
There were no statistically significant differences between the NW and control group
characteristics at baseline (Tables 1 & 2). No training-related injuries were reported in
the NW group.
<Table 1> Characteristics of participants in the Nordic Walking group and the Control
group
NW CO
Variable Mean SD Mean SD P-value
No. participants (Male/Female) 19 (5/14) 19 (5/14) NS
Age (yr) 66.7 ± 4.5 68.0 ± 4.6 NS
Height (cm) 152.6 ± 6.9 155.3 ± 7.4 NS
Weight (kg) 60.4 ± 9.7 58.0 ± 8.1 NS
BMI (kg・m-2) 25.9 ± 3.8 24.1 ± 2.9 NS
SBP (mmHg) 148 ± 20 140 ± 17 NS
DBP (mmHg) 86 ± 13 82 ± 11 NS
HR (bpm) 83 ± 14 84 ± 13 NS
Hypertension 9 6 NS
Diabetes 3 4 NS
Dyslipidemia 7 6 NS
Heart disease 3 3 NS
Osteoporosis 1 1 NS
Musculoskeletal pain 8 14 NS
Values are expressed as mean and SD. The last column shows the significance values (p)
of the differences. Abbreviations: NW=Nordic walking group, CO=Control group,
SD=standard deviation, BMI=Body Mass Index, SBP=Systolic Blood Pressure,
DBP=Diastolic Blood Pressure, HR=heart rate
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<Table 2> Summary of results-physical fitness tests at baseline in the Nordic Walking
group (NW) and the Control group (CO).
NW CO
Variables Mean SD Mean SD P-value
TUG-N Sec 8.4 ± 0.9 8.1 ± 1.1 NS
TUG-M Sec 6.4 ± 0.8 6.1 ± 1.1 NS
Sit-and-reach Cm 27.7 ± 7.2 31.3 ± 9.0 NS
Leg strength Right, Nm 80.8 ± 23.9 97.5 ± 39.2 NS
Right, Nm/kg 1.34 ± 0.37 1.57 ± 0.52 NS
Left, Nm 89.2 ± 29.0 110.0 ± 36.2 NS
Left, Nm/kg 1.50 ± 0.47 1.69 ± 0.48 NS
ISWT No. of shuttles 45.1 ± 10.6 50.2 ± 12.3 NS
Values are expressed as mean and SD. The last column shows the significance values (p) of the
differences. Abbreviations: TUG-N=timed-up-and go test at normal walking speed,
TUG-M=timed-up and go test at maximal walking speed, ISWT=incremental shuttle walking test.
2. Changes observed
Although body weight in the NW was unchanged after the training period, there was a
slight but significant increase in the control group (p < 0.05). During the 2nd and 11th
training sessions, the average HR during the 800 m NW increased from 122±17 bpm (2nd
session) to 130±16 bpm (11th training session) at a self-selected comfortable speed. The
average walking speed was significantly (p < 0.05) faster at the 11th training session
(1.46±0.14 m/s) compared to the 2nd session (1.58±0.15 m/s), whereas their RPE was
similar for all sessions (2nd: 12.3±1.7 vs. 11th: 11.6 ±1.3).
-20 -10 0 10 20 30 40
TUG-N
TUG-M
Sit-and-Reach
Right Leg Strength
Left Leg Strength
ISWT shuttles NW CO
%change (post - pre / pre × 100)
<Figure 2> Percentage of change in physical fitness scores from baseline to 8 weeks
after the Nordic Walking exercise (NW) and control treatment (CO).
TUG-N: timed-up-and go test at normal walking speed.
TUG-M: timed-up and go test at maximal walking speed.
ISWT: incremental shuttle walking test.
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60
70
80
90
100
110
120
130
140
150
160
170
00:00
00:30
01:00
01:30
02:00
02:30
03:00
03:30
04:00
04:30
05:00
05:30
06:00
06:30
07:00
NW pre
NW post
Time (min:sec)
HR (bpm)
*
*
**
**
**
**
*
60
70
80
90
100
110
120
130
140
150
160
170
00:00
00:30
01:00
01:30
02:00
02:30
03:00
03:30
04:00
04:30
05:00
05:30
06:00
06:30
07:00
CO pre
CO post
Time (min:sec)
HR (bpm)
Figure 2 shows the results of the physical fitness test. In the NW group, training had
positive effects (p < 0.05) on the TUG, flexibility, and knee extension strength (left leg). In
contrast, bilateral knee extension strength was decreased in the control group during the
same period (p < 0.05). There were no statistically significant differences between the
first and second ISWT in the number of shuttles completed in the NW group (baseline:
45.1±10.6 shuttles vs. post NW: 44.4±9.7 shuttles). However, the control group performed
fewer shuttles in the second test compared to the first test (baseline: 50.2±12.3 shuttles
vs. post-Control: 47.1±9.8 shuttles). All subjects achieved more than level 6 (walking
speed at level 6: 82 m/min). During the ISWT, the NW group walked with significantly
lower HRs from level 1–5 after the 8-week training period (p < 0.05). However, there was
no difference in HRs in the control group (Figure 3).
<Figure 3> Heart rate (HR) response during the incremental shuttle walk test for the
Nordic walking (NW: left graph) and control (CO: right graph) groups at baseline (Pre)
and 8 weeks after the intervention period (Post).
The symbols and error bars express mean ± SD. *p < 0.05 pre- vs. post-intervention
period within the group.
In the force platform measurements (Table 3), all subjects were able to perform four
standing positions for 30 s periods. As expected, average higher values were observed for
most variables in the tandem stance. TL and SaV were significantly different between
the groups in the normal standing condition with only eyes open (p < 0.05), however,
there were no statistically significant changes between the groups in any of four balance
tests.
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<Table 3> Mean and standard deviation (SD) of balance variables on the force platform in
the Nordic walking group (NW) and the control group (CO).
COP movement
variable TL (mm) C90A (mm2) StdV (mm/s) SaV (mm/s)
(1) Eyes open Mean SE Mean SE Mean SE Mean SE
CO Pre 325.1 17.6 266.4 35.1 6.3 0.3 10.8 0.6
Post 365.7* 20.3 286.1 45.1 6.8 0.6 12.2* 0.7
NW Pre 341.9 22.4 242.7 35.0 6.1 0.4 11.4 0.7
Post 347.1 22.1 236.0 27.1 6.0 0.3 11.6 0.7
(2) Eyes closed
CO Pre 450.1 28.1 393.0 60.3 8.7 0.6 15.0 0.9
Post 445.0 25.2 381.4 69.1 8.2 0.6 14.8 0.8
NW Pre 450.9 33.0 319.5 38.2 8.0 0.5 15.0 1.1
Post 476.3 26.8 362.9 50.1 8.3 0.5 15.9 0.9
(3) Semi-tandem
CO Pre 494.6 25.4 386.5 53.7 9.0 0.5 16.5 0.8
Post 467.2 20.9 365.6 56.8 8.7 0.4 15.6 0.7
NW Pre 491.4 31.7 283.6 32.2 8.5 0.5 16.4 1.1
Post 499.6 37.3 336.1 39.1 8.7 0.6 16.7 1.2
(4) Tandem
CO Pre 595.1 31.3 337.0 27.9 10.7 0.5 19.8 1.0
Post 652.4 37.4 385.2 49.7 11.7 0.6 21.7 1.2
NW Pre 650.2 53.6 304.7 31.5 10.8 0.7 21.7 1.8
Post 672.7 55.7 387.6 83.4 11.1 0.6 22.4 1.9
Outcome variables were: TL = trace length, C90 Area = area of the 90% confidence ellipse, StdV = Standard
deviation velocity, SaV = sway average velocity. *p < 0.05 pre- vs post-intervention period within group.
IV. Discussion
This study indicates that 8 weeks of the NW program either improved or maintained
functional mobility, flexibility, and leg strength with measurable changes in static
balance as assessed by the balance platform. As training progressed, NW became a
relatively high intensity activity for the elderly.
In older adults, NW or walking with poles seems to have had potential benefits with
reduced load to the lower extremities at a controlled walking speed (Strutzenberger, Rasp,
Schwameder, 2007) as well as enhanced cardiorespiratory fitness (Stoughton, 1992)
Kukkonen-Harjula, Hiilloskorpi, Mänttäri, et al., 2007). However, a recent study showed
the lack of a loading effect. Despite its popularity, few studies have assessed the training
effects on functional capacity and balance in the elderly. Improvement of the TUG and
flexibility produced better results.
Recently, Kukkonen-Harjula, Hiilloskorpi, Mänttäri, et al. (2007) reported that
improvement of peak VO2 was modest (from 26.0 to 28.4 ml/kg/min) in middle-aged (54±3
years old) sedentary women in response to 13 weeks of training, four times per week for
40 minutes per day. They also reported that normal walking, rather than NW improved
leg strength assessed by the one leg squat test. Unfortunately, information regarding
walking speed, distance, or training environment during the training period was not
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reported in the previous study (Kukkonen-Harjula, Hiilloskorpi, Mänttäri, et al., 2007).
We found that NW speed was also significantly faster after the 11th session of training. In
addition, isometric knee extensor strength improved after the NW training.
To assess endurance capacity for the elderly in the present study, we used the ISWT.
Oxygen uptake has been correlated with distance walked during ISWT in
post-myocardial infarction patients and in healthy adults (Woolf-May & Ferrett, 2008). A
training effect was observed in the NW group evidence by a decrease in exercise HR at a
given submaximal walking speed. After training, however, the number of shuttles
achieved at the ISWT did not increase in the NW group. In contrast, there was slight but
statistically significant decrease in the number of shuttles in the control group. Although
walking with a pole assists subjects to walk faster and widen step length, the shorter
heights (range 152–155 cm) of the subjects might have limited their ability to keep up
with the speed at higher stages of the ISWT.
Therefore, with a proper poling technique, NW increases the length of steps and
promotes walking at a higher speed than walking at normal speed with a reduced
subjective perception of fatigue and increased safety of walking with poles (Church,
Earnest & Morss, 2002; van Eijkeren FJM, Reijmers RSJ, Kleinveld, et al., 2008) in the
elderly. Based on the peak HR during the ISWT, we assessed the individual’s training
intensity by expressing the 800-m walk HR as a percent of HR reserve (%HRR) at the 2nd
and 11th sessions. Although, the RPEs were similar between the sessions (2nd: 12.3±1.7
vs. 11th: 11.6 ±1.3), their walking speed improved significantly from the 2nd to the 11th
session. In addition, the %HRR values also increased from 68±15% during the 2nd session
to 77±17% during the 11th session. According to the American College of Sports Medicine
guidelines, exercise at an intensity equivalent to 60–84% of HRR is considered “hard” or
“vigorous” (Woledge, Birtles & Newham, 2005). NW is often viewed favorably as exercise
in terms of energy expenditure. However, with regard to the safety of this type of exercise
among the elderly, precautions should be taken given the discrepancy between subjective
feeling of intensity (RPE) and the physiological basis of intensity (i.e., %HRR).
Traditionally, moderate (40–59 %HRR) intensity activities are preferred among older
adults, especially for those with chronic diseases. Schiffer, Knicker, Hoffman, et al. (2006)
reported that both HR and oxygen consumption responses were similar for NW and
jogging at both 6.4 km/h and 7.5 km/h. They also found that based on lactate
concentrations, training recommendations derived from walking tests would
underestimate NW loads when training intensity was determined using monitoring of
HR. Moreover, an increase in walking speed led to a more dynamic walking pattern and
simultaneously led to increased ground force in the first part of the stance phase
(Strutzenberger, Rasp & Schwameder, 2007) while the load on the knee joint may also
increase (Thapa, Gideon, Brockman et al., 1996). Therefore, when introducing NW to
previously sedentary elderly individuals, an initial physical activity assessment is
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essential and should include monitoring of exercise intensity using a HR monitor or pulse
counting to improve safety.
Our findings provide further evidence for walking and NW as effective forms of
exercise that help to maintain or improve endurance capacity. Previous studies, using
maximum oxygen treadmill testing in walking programs of greater than 12-week
duration, found increases in fitness ranging from 8–30% (Paillard, Lafont, Costes-Salon,
et al., 2003; Hardman & Hudson, 1994). In agreement our results, Kukkonen-Harjula et
al. (Kukkonen-Harjula, Hiilloskorpi, Mänttäri, et al., 2007) also reported that 13 weeks
of NW attenuated the submaximal cardiovascular response and enhanced the peak VO2
level as much as normal walking.
Eight weeks of NW did not affect balance variables. Walking is an unstable activity
and lateral sway during walking is increased in older adults (Woledge, Birtles &
Newham, 2005). An increased in COP movement in the force platform balance test was
seen in older individuals (Thapa, Gideon, Brockman, et al, 1996; Maki, Holliday & Topper
AK, 1994; Era, Schroll, Ytting, et al., 1996) and some prospective studies showed that
increased COP movement correlated with risk of falls (Bergland, Jarnlo & Laake, 2003;
Bergland & Wyller, 2004; Stela, Smitb, Pluijma et al., 2003). With increasing age, step
width increased and step length and stride velocity decreased (Winter, 1991). In
agreement with the results of a previous study (Era, Sainio, Koskinen, et al, 2006),
tandem stands are challenging for elderly. Tandem standing, in particular, requires
muscle strength and endurance to maintain the posture against a narrowed base of
support in the medio-lateral direction (Jonsson, Seiger & Hirschfeld, 2005). Reduction of
foot impact and support from the poles while walking may be responsible for the lack of
changes in the balance variables assessed by the balance platform tests. Furthermore,
our subjects were relatively healthy, and their balance was very good even before
intervention (Era, Sainio, Koskinen, et al, 2006). Previous studies have shown that both
in healthy and active older individuals falls were more often associated with the demands
of the activity they engaged in (Hill, Schwarz, Flicker et al., 1999; Bath & Morgan, 1999).
Therefore, the engagement in previous physical and sports activities might have
contributed to the lack of change observed in the static balance test in our study. Further
studies need to assess the impact of prolonged (i.e. 3 months or more [Howe, Rochester,
Neil, et al., 2011]) of NW exercise on both static and dynamic balance controls in this
population.
In conclusion, a structured 8-week NW exercise program achieved good results in
maintaining functional mobility in elderly Japanese men and women. Static balance
assessed by the balance platform, however, did not change during the intervention
period.
DOI:http://doi.org/10.4391/ajhs.15.38
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Acknowledgments
The authors wish to thank our many colleagues in the Proactive Health and Well-being
center at the Tohoku Fukushi University and Sendai-Finland Wellbeing Center. In
addition, we would especially like to thank the participants and exercise volunteers from
the town of Yamamoto.
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- Editorial Board -
Editor-in-Chief Masahiro KOHZUKI Tohoku University (Japan)
Executive Editors Injae LEE
Satoru EBIHARA
Hanshin Univerisity (Korea)
Toho University (Japan)
Changwan HAN
University of the Ryukyus
(Japan)
Jenyi LI
Nanyang Technological University
(Singapore)
Sunwoo LEE
Inje University
(Korea)
Guo QI
Tianjin Medical University
(China)
Jung Won SONN
University College London
(UK)
Taekyun YOO
Soongsil University
(Korea)
Hsintai LIN
National Taiwan Noraml University
(Taiwan)
Kagari SHIBAZAKI
University of Huddersfield
(UK)
Youngchoul KIM
University of Evansville
(USA)
Inkeri RUOKONEN
University of Helsinki
(Finland)
Nigel A MARSHALL
University of Sussex
(UK)
Yuichiro HARUNA
National Institute of Vocational
Rehabilitation
(Japan)
Zhongli JIANG
First Affiliated Hospital of
Nanjing Medical University
(China)
Jaewon LEE
Pukyong National University
(Korea)
Osamu ITO
Tohoku Medical and
Pharmaceutical University
(Japan)
Petr DOBŠÁK
Masaryk University
(Czech)
Editorial Staff
- Editorial
Assistants
Aiko KOHARA
Marcus Eije Zantere
Moonjung KIM
Natsuki YANO
University of the Ryukyus (Japan)
University of Gothenburg (Sweden)
Korea Labor Force Development Institute for the aged (Korea)
Tohoku University / University of the Ryukyus (Japan)
Asian Journal of Human Services
VOL.15 Ocober 2018 © 2018 Asian Society of Human Services
Editor-in-Chief Masahiro KOHZUKI
Presidents Masahiro KOHZUKI・Sunwoo LEE
Publisher Asian Society of Human Services
Faculty of Education, University of the Ryukyus, 1 Senbaru, Nishihara, Nakagami, Okinawa, Japan
FAX: +81-098-895-8420 E-mail: ashs201091@gmail.com
Production Asian Society of Human Services Press
Faculty of Education, University of the Ryukyus, 1 Senbaru, Nishihara, Nakagami, Okinawa, Japan
FAX: +81-098-895-8420 E-mail: ashs201091@gmail.com
Asian Journal of Human Services
VOL.15 October 2018
CONTENTS
ORIGINAL ARTICLES
Using Videos to Analyze the Effectiveness of START Education for Japanese Nursing Students
Kazuyuki AKINAGA et al., 1
Effects of the OSCE to Motivate Students to Learn Before Clinical Practice
Yuko FUJIO et al., 13
The Current Status and Its Implications of Public-Private Partnerships for Official Development
Assistance in Korea: Focusing on Disability-Inclusive Development Cooperation
Juhee HWANG et al., 25
Effects of a Structured 8-week Nordic Walking Exercise Program on Physical Fitness in the Japanese
Elderly
Kimiko YAMAMOTO et al., 38
Study of “Individuality” on Nursing Care Job
Kimiko YAMAMOTO et al., 52
SHORT PAPERS
A Comparison of the Factor Structure of the Self-Harm Antipathy Scale and related Demographic
Characteristics between Korea and Japan
Yoshimi AOKI et al., 66
Issues of Specific Educational Curriculum Development for Resource Rooms and Special Needs Classes
in Japanese High Schools
Mitsuyo SHIMOJO et al., 76
REVIEW ARTICLES
Importance of Physical Activity and V.O2max: Five Major Determinants of V
.O2max
Masahiro KOHZUKI et al., 85
Importance of Physical Exercise in Oldest-old Adults: A Literature Review Study
Chaeyoon CHO et al., 93
Published by
Asian Society of Human Services
Okinawa, Japan